Pawning the future



Clinic “Do you have any trouble following the rules?” The boy, 11, shakes his head “no,” but the opacity of his expression says he often feels wrongly blamed. He is having a problem with a fragile cerebral faculty, executive function, the seat of personal responsibility. You can spell it out in the acronym ISIS, which outlines how we command our own attention and doings: I=initiate; S=sustain; I=inhibit; S= shift. Many parents from Armenia’s outlying regions bring their incorrigible boys to the niartaban (neurologist). The response: a few wise words on parenting, on to the psychologist. But the parents are right: aggressive, impulsive behavior can indicate a brain problem–lead poisoning.

For post-Soviet countries, lead exposure is a pervasive health hazard. (The other is radioactive tailings from uranium mines.) So I ask my pediatrician colleagues: what about measuring lead in this boy, and others like him? The idea that an environmental pollutant could contribute to poor self-control, to this boy’s growing disappointments, is new to them.



In the US, the clinical studies of Herbert Needleman, among others, improved the intelligence and executive skills of millions of American children, since the findings prompted mass screening of children for lead exposure. Needleman began by usurping the tooth fairy’s role, measuring the lead content of children’s deciduous teeth. We now know that any measurable lead level means the brain’s capacity for reason, for self-control, is taking a hit. Though Needleman’s reputation was attacked by lead industry “representatives,” he was a good tooth fairy, since, through standards spawned by his research, he gave back more than those children could have wished for–growth conditions to better support their sense of personal responsibility.

Armenia has the makings of a perfect storm of pediatric lead poisoning: (1) low awareness among clinicians about the potential magnitude of the problem; (2) no laboratory to measure lead; (3) government facilitates mining operations (~600 mines scattered over territory the size of Maryland, over 50% of exports) with little regulation; (4) lead, leaching out of mine tailings, accumulates in crops and water; (5) no effective legal recourse for poisonings sustained by mine-workers or communities.

When I was 11, I proudly announced that I had incorporated some of the contents of a jar marked “Benzene” into my chemistry set recipes; initiate. This is the schoolboy who, absorbed in his daydreams, thought “pay attention!” was one word; sustain. In one shocking parental lecture, I learned about the latent effects of poisons, and cancer.

What if, someday, those parents from the outlying regions learn that their ‘bad boys’ have high lead levels, and what that means? Denial, grief, anger, … regulation? To me, regulation is a core executive skill; inhibit. For others, regulation to counter lead pollution doesn’t compute. “Government action can only detract from personal responsibility!” say my libertarian friends. But I remember how I felt that day when I was 11: “My future, pawned for an afternoon adventure!Shift.



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